单侧双通道内镜下腰椎间融合术与后路中线腰椎融合术治疗腰椎退行性疾病的临床疗效比较

Comparison of clinical efficacies between unilateral biportal endoscopic lumbar interbody fusion and midline lumbar fusion in the treatment of lumbar degenerative diseases

中文关键词:  单侧双通道内镜下腰椎间融合术  后路中线腰椎融合术  腰椎退行性疾病

英文关键词:Unilateral biportal endoscopic lumbar interbody fusion  Midline lumbar fusion  Degenerative lumbar diseases

中文摘要:

  【摘要】 目的：比较单侧双通道内镜下腰椎间融合术（unilateral biportal endoscopic lumbar interbody fusion，ULIF）与后路中线腰椎融合术（midline lumbar fusion，MIDLF）治疗腰椎退行性疾病的临床疗效。方法：回顾性分析我院自2020年1月~2022年1月接受ULIF及MIDLF手术治疗的腰椎退变性疾病患者42例，其中ULIF组20例，MIDLF组22例，两组患者年龄、性别、主要诊断、手术节段等一般资料差异无统计学意义（P＞0.05）。记录两组患者术前、术后1周、术后3个月、术后6个月及末次随访时腰痛视觉模拟量表（visual analogue scale，VAS）评分、腿痛VAS评分、Oswestry功能障碍指数（Oswestry disability index，ODI）进行临床疗效评估，以及两组手术时间、术后引流量、住院天数、手术并发症发生率。术后6个月进行腰椎CT检查，以Bridwell标准评估两组患者的椎间融合情况。结果：ULIF组随访12~18个月（14.2±2.0个月），MIDLF组随访12~17个月（14.4±1.5个月），差异无统计学意义（P＞0.05）。ULIF组手术时间225.68±56.43min、术后引流量92.3±69.7mL、住院天数7.1±2.1d，MIDLF组手术时间163±31.2min、术后引流量137.5±99.4mL、住院天数12.2±3.3d，两组比较差异均具有统计学意义（P＜0.05）。两组患者腰痛及腿痛VAS评分及ODI在术后1周、3个月、6个月、末次随访均比术前明显改善（P＜0.05）；两组间患者术前、术后6个月、末次随访腰痛及腿痛VAS评分差异无统计学意义（P＞0.05），术后1周及术后3个月腰痛及腿痛VAS评分ULIF组优于MIDLF组（P＜0.05）。两组患者术前、术后1周、术后3个月、术后6个月及末次随访ODI差异无统计学意义（P＞0.05）。术后6个月椎间融合评估，ULIF组Ⅰ级融合11例、Ⅱ级融合6例，MIDLF组Ⅰ级融合14例、Ⅱ级融合5例，两组患者融合率差异无统计学意义（P＞0.05）。ULIF组发生硬脊膜撕裂1例，MIDLF组未发生手术相关并发症。结论：ULIF及MIDLF两种术式均可以达到神经充分减压以及椎间良好融合的目的，取得良好的临床效果，ULIF在患者早期的康复更具优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacies of unilateral biportal endoscopic lumbar interbody fusion(ULIF) and midline lumbar fusion(MIDLF) in the treatment of lumbar degenerative diseases. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent ULIF and MIDLF surgeries for lumbar degenerative diseases in our hospital from January 2020 to January 2022. A total of 42 patients were included, with 20 cases in the ULIF group and 22 cases in the MIDLF group. There were no statistically significant differences in general data such as age, gender, diagnosis, and surgical segments between the two groups(P>0.05). The clinical efficacy was evaluated by recording the visual analogue scale(VAS) scores for low back pain and leg pain, Oswestry disability index(ODI) at preoperation, postoperative 1 week, 3 months, 6 months, and at final follow-up, as well as the surgical time, postoperative drainage volume, length of hospital stay, and incidence of surgical complications in both groups. Lumbar CT examination was performed at 6 months postoperatively to evaluate the interbody fusion status of the two groups of patients according to the Bridwell criteria. Results: The follow-up duration was 12 to 18 months(14.2±2.0 months) in the ULIF group and 12 to 17 months(14.4±1.5 months) in the MIDLF group, with no statistically significant difference(P>0.05). In the ULIF group, the surgical time was 225.68±56.43min, postoperative drainage volume was 92.3±69.7mL, and length of hospital stay was 7.1±2.1d, while in the MIDLF group, the surgical time was 163±31.2min, postoperative drainage volume was 137.5±99.4mL, and length of hospital stay was 12.2±3.3d; the differences between the two groups were statistically significant(P<0.05). The VAS scores for low back pain and leg pain as well as ODI in both groups showed significant improvement at postoperative 1 week, 3 months, 6 months, and final follow-up compared to preoperative values(P<0.05). There were no statistically significant differences in VAS scores for low back pain and leg pain between the two groups at preoperation, postoperative 6 months, and final follow-up(P>0.05), and the ULIF group showed better scores than the MIDLF group at postoperative 1 week and 3 months(P<0.05). There were no statistically significant differences in ODI between the two groups at preoperation, postoperative 1 week, 3 months, 6 months, and final follow-up(P>0.05). At 6 months postoperatively, fusion assessment showed that in the ULIF group, there were 11 cases of grade Ⅰ fusion and 6 cases of grade Ⅱ fusion, while in the MIDLF group, there were 14 cases of grade Ⅰ fusion and 5 cases of grade Ⅱ fusion; the fusion rates did not differ significantly between the two groups(P>0.05). 1 case of dural tear occurred in the ULIF group, while no surgery-related complications occurred in the MIDLF group. Conclusions: Both ULIF and MIDLF procedures can achieve sufficient neural decompression and good interbody fusion, resulting in good clinical outcomes. ULIF has an advantage in early patient recovery.